Health surveys. Supervision (much more) from the patients perspective. Charlotte Hjort Head of dep., MD, ph.d., MPG

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1 Health surveys Supervision (much more) from the patients perspective Charlotte Hjort Head of dep., MD, ph.d., MPG

The story 2002 Act on surveys at all nursing homes (frequentbased surveys) 600-800 per year 2017 Act on surveys concerning health issues at 10% of all health institutions incl.

2 The story 2002 Act on surveys at all nursing homes (frequentbased surveys) per year 2017 Act on surveys concerning health issues at 10% of all health institutions incl. nursing homes (risk-based surveys) Politicians have changed the system from covering few types of health institutions to covering the whole health care system. That meant fewer surveys at nursing homes Up to 250 per year Lobbyism from patients organisations: Elderly people is a vulnerable group in the society it is a mistake to perform fewer surveys at nursing homes 2018 Political deal of an extra survey It is implemented as two different types of surveys at the same institutions from the same authority (Dansih Patients Safety Authority) per year

3 - and in addition!! A survey conducted by the municipalities themselves (det kommunale tilsyn)

4 Two different types of surveys

5 Two different laws The Health Act (Sundhedsloven) health issues (medication, recording of patient data, indication for diagnostic analysis and treatment, control and follow-up, etc.) Consolidation Act on Social Service (Serviceloven) service issues (self-determination, life quality, relations, organisation, competences, procedures og documentation, rehabilitation, etc.)

6 Survey method Opening interview with the management Triangulation (interview, observation, documentation) Health: Management, employees Service: Citizens or their relatives, management, employees, Time-out Closing interview with the management Emphasis on learning 12. oktober 2018

7 Typical indicator health survey 9: Gennemgang af og interview om instruks for rammedelegation Tilsynsførende gennemgår instruks for rammedelegation for lægeforbeholdt virksomhedsområde med ledelsen og interviewer personalet, om de kender og følger instruksen. Instruksen skal foreligge på de behandlingssteder, hvor personalet udfører lægeforbeholdt virksomhed. a. Ved gennemgang af instruksen skal følgende fremgå: at omfang, og håndtering af rammedelegation er patientsikkerhedsmæssigt forsvarligt b. Personalet er interviewet, om de kender og følger instruksen, jf. ovennævnte punkt. Referencer: Bekendtgørelse om autoriserede sundhedspersoners benyttelse af medhjælp (delegation af forbeholdt sundhedsfaglig virksomhed), BEK nr af 11. december 2009 Vejledning om autoriserede sundhedspersoners benyttelse af medhjælp (delegation af forbeholdt sundhedsfaglig virksomhed), VEJ nr. 115 af 11. december 2009 Opfyldt Ikke opfyldt Ikke aktuelt 9a. Gennemgang af instruks for rammedelegation. Instruks opfylder krav 9b. Interview om instruks for rammedelegation. Personalet kender og følger instruksen Fund og kommentarer: 12. oktober 2018

8 Typical indicator service survey Målepunkt 1.2 Pleje af borgere ved livets afslutning Målepunktet omhandler, hvordan plejeenheden med udgangspunkt i borgerens ønsker varetager pleje og omsorg, herunder pleje og omsorg ved livets afslutning. Målepunktet vil blive vurderet på baggrund af dialog med borgere tilknyttet plejeenheden, eventuelt pårørende samt ledelsen og medarbejdere 12. oktober 2018

9 After survey Scoring in four groups (0-3) after survey Shipment of report Hearing in three weeks Supplement - conclusion after hearing Publication at homepage 12. oktober 2018

10 Categories and possible sanctions No problems Less problems recommandation +/- plan for improvement Bigger problems injunction Critical problems prohibition

11 Patientjourney project of methotrexat Survey on specialist (dermatologists, rheumatologist) Survey on general practitioners Survey on nursing homes and home nursing 12. oktober 2018

12 Development issues main questions How to balance the focus between the hard core patientsafety and the well-being of the patient/citizen? - The operations went well, but the patient died - The patient was so satisfied with pain killers (morphin), but he died from a missed acute bowel disease How to include patients/citizens in the best way?

13 Thank you for your attention 12. oktober 2018